Abdominal Wall Endometriosis That Developed at the Port Site after Laparoscopic Cholecystectomy

Abstract Introduction: Laparoscopic cholecystectomy (LC) has been widely used by surgeons. However, a serious but rare condition may be happened, which is the missed diagnosis of intraperitoneal malignant tumor. If the malignancy exists, the changes of the abdominal environment or the laparoscopic operation might brought the cancer cells to the abdominal cavity or the abdominal wall. The missed laparoscopic malignant tumors are prone to metastasis, especially at the laparoscopic port-site. More extreme condition will be located in the navel, which is known as Sister Mary Joseph’s nodule(SMJN).Case presentation: A 63-year-old female who had undergone cholecystectomy and choledocholithotomy ten months ago was hospitalized for upper abdominal pain. Laboratory examination indicated that the most of tumor markers were increased. CT scan revealed that there was a diffused irregular and progressively enhanced mass around the left lobe bile duct, multiple enlarged lymph nodes in the abdominal cavity and multiple nodular lesions were found under the costal margin of the right upper abdominal wall, right lower abdominal wall and the umbilicus. Biopsy of the nodules under the original surgical scar showed an infiltrative or metastatic middle differentiated adenocarcinoma. So the diagnosis was left lobe cholangiocarcinoma of the liver, multiple lymph nodes metastasis in the abdominal cavity and multiple implant metastasis in abdominal wall laparoscopic port-site and umbilical.Conclusion: In laparoscopic cholecystectomy, surgeons should not only focus on the local lesions, like gallstone in biliary system, but also look around other the tissues and organs to avoid missing the abdominal malignant tumor or other lesions. When atypical symptoms or abnormalities have been found pre-operation, all abdominal organs should be evaluated in detail to avoid missed diagnosis of potential malignant tumors. On the other hand, when there is a nodule in the umbilicus, all the organs and tissues in abdomen should be examined to find the potential malignant tumor. Finally, multiple cholelithiasis in the left lobe of the liver should be regarded as a high risk factor for cholangiocarcinoma.

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A Patient with Incidental Gallbladder Carcinoma who Survived for 7 Years and 2 Months after Abdominal Wall Resection for Port Site Recurrence after Laparoscopic Cholecystectomy

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.74.3170 ◽

2013 ◽

Vol 74 (11) ◽

pp. 3170-3175 ◽

Cited By ~ 1

Author(s):

Katsumi AMIKURA ◽

Toshiro OGURA ◽

Hirohiko SAKAMOTO ◽

Yoichi TANAKA ◽

Masashi KUROSUMI

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Wall ◽

Gallbladder Carcinoma ◽

Port Site ◽

Port Site Recurrence

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Expression of p63 Differs in Peritoneal Endometriosis, Endometriomas, Adenomyosis, Rectovaginal Septum Endometriosis, and Abdominal Wall Endometriosis

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(08)70635-2 ◽

2008 ◽

Vol 2008 ◽

pp. 166-169

Author(s):

A. Parwani

Keyword(s):

Abdominal Wall ◽

Rectovaginal Septum ◽

Abdominal Wall Endometriosis ◽

Peritoneal Endometriosis

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Radiologic Findings of Abdominal Wall Endometriosis

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2003.49.6.489 ◽

2003 ◽

Vol 49 (6) ◽

pp. 489

Author(s):

Jung Wook Seo

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Endometriosis ◽

Radiologic Findings

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Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar

HPB Surgery ◽

10.1155/2011/761315 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Kamil Gulpinar ◽

Suleyman Ozdemir ◽

S. Erpulat Ozis ◽

Turgut Aydin ◽

Atila Korkmaz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Complications ◽

Abdominal Wall ◽

Single Incision ◽

Single Port ◽

Operation Time ◽

Scar Formation ◽

Single Incision Laparoscopic Cholecystectomy ◽

Skin Scar

Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization.

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Evaluation of Cases of Abdominal Wall Endometriosis at Universidade Estadual de Campinas in a period of 10 Years

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1603965 ◽

2017 ◽

Vol 39 (08) ◽

pp. 403-407 ◽

Cited By ~ 5

Author(s):

Daniela Yela ◽

Lucas Trigo ◽

Cristina Benetti-Pinto

Keyword(s):

Cesarean Section ◽

Abdominal Wall ◽

Recurrence Rate ◽

Clinical Manifestations ◽

Disease Recurrence ◽

Surgical Margins ◽

Abdominal Wall Endometriosis ◽

Postoperative Control ◽

Epidemiological Characteristics ◽

Previous Cesarean

Purpose To determine the clinical and epidemiological characteristics of abdominal wall endometriosis (AWE), as well as the rate and recurrence factors for the disease. Methods A retrospective study of 52 women with AWE was performed at Universidade Estadual de Campinas from 2004 to 2014. Of the 231 surgeries performed for the diagnosis of endometriosis, 52 women were found to have abdominal wall endometriosis (AWE). The frequencies, means and standard deviations of the clinical characteristics of these women were calculated, as well as the recurrence rate of AWE. To determine the risk factors for disease recurrence, Fisher's exact test was used. Results The mean age of the patients was 30.71 ± 5.91 years. The main clinical manifestations were pain (98%) and sensation of a mass (36.5%). We observed that 94% of these women had undergone at least 1 cesarean section, and 73% had used medication for the postoperative control of endometriosis. The lesion was most commonly located in the cesarean section scar (65%). The recurrence rate of the disease was of 26.9%. All 14 women who had relapsed had surgical margins compromised in the previous surgery. There was no correlation between recurrent AWE and a previous cesarean section (p = 0.18), previous laparotomy (p = 0.11), previous laparoscopy (p = 0.12) and postoperative hormone therapy (p = 0.51). Conclusion Women with previous cesarean sections with local pain or lumps should be investigated for AWE. The recurrence of AWE is high, especially when the first surgery is not appropriate and leaves compromised surgical margins.

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